- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.06 / $1,857.07 / $1,857.07
| Facility | | $1,857.06 | $1,857.07 | $1,857.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.06 / $1,857.07 / $1,857.07
| Professional | | $1,857.06 | $1,857.07 | $1,857.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.24 / $1,709.18 / $2,219.53
| Facility | | $942.24 | $1,709.18 | $2,219.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,660.51 / $1,660.51 / $1,693.72
| Professional | | $1,660.51 | $1,660.51 | $1,693.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.14 / $2,039.14 / $2,039.14
| Facility | | $2,039.14 | $2,039.14 | $2,039.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.14 / $2,039.14 / $2,039.14
| Professional | | $2,039.14 | $2,039.14 | $2,039.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,781.82 / $2,119.07 / $2,250.34
| Professional | | $1,781.82 | $2,119.07 | $2,250.34 |